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| Cardiac troponin I can independently predicts mortality in patients with severe sepsis and septic
shock |
| HU Tian- tian，ZHAO Guang- ju，HONG Guang- liang，LI Meng- fang，ZHI Shao- ce，WU Bin，LU Zhong-qiu |
| Department of Emergency，the First Affiliated Hospital of Wenzhou Medical University，Wenzhou 325000，China |
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Abstract Objective To evaluate the prognostic value of cardiac troponin I in severe sepsis and septic shock patients. Methods We retrospectively selected 86 severe sepsis and septic shock patients who admitted to EICU，ICU of our hospital from Jan. 1，2013 to Dec. 13，2014. According to cTnI levels the patients were divided to groupⅠ（cTnI≤0.08 ng/mL）and groupⅡ（cTnI＞0.08 ng/mL）; total hospital mortality，ICU mortality and total hospitalization days and the ICU hospitalization days between the two groups were compared. According to whether the survival of the hospital 28 days they were divided into survival group and death group; cTnI level was statistically compared and its prognostic value was also evaluated. Results A total of 86 patients were recruited in the study. GroupⅠcompared with groupⅡ，the total hospital mortality（12.5% compared to 50.9%，P＜0.01）; ICU mortality（12.5% compared to 42.6%，P＜0.01）; the total number of hospital days [10（7，17）than 11（6，20），P＞0.05]; ICU hospi⁃talization days [4（2，9）than 6（3，9），P＞0.05]. Survival group compared with death group，its body
temperature，breathing，heart rate，cTnI，lactic acid，the number of organ involvement and APACHEⅡ scores were significantly lower than those in the death group（P＜0.01），but age，sex，blood pressure，leukocytes，platelets and other indicators had no obvious difference compared with the death group
（P＞0.05）. Using logistic regression analysis of cardiac cTnI＞0.08 ng/mL，temperature，lactic acid
and number of organ involvement can be used as an independent predictor of mortality in hospitalized
patients. Conclusion cTnI＞0.08 ng/mL in patients with severe sepsis and septic shock，their total
hospital mortality rates and ICU mortality increases and cTnI can be used as an independent predictor of mortality.
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Received: 28 October 2015
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Corresponding Authors:
LU Zhong-qiu，E-mail: Lzq640815@163.com
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| [1] Parrillo JE，Parker MM，Natanson C，et al. Septic shock in humans: advances in the understanding of pathogenesis，cardiovascular dysfunction，and therapy[J]. Ann Internal Med，1990，113（3）:227-242.
[2] Padkin A，Goldfrad C，Brady AR，et al. Epidemiology of severe sepsis occurring in the first 24 hrs in
intensive care units in England，Wales，and Northern Ireland[J]. Crit Care Med，2003，31（9）: 2332-2338.
[3] Yende S，Angus DC. Long-term outcomes from sepsis[J]. Current Infectious Disease Reports，2007，9（5）:
382-386.
[4] 高戈，冯喆，常志刚，等. 2012 国际严重脓毒症及脓毒性休克诊疗指南[J]. 中华危重病急救医学，2013，25（8）: 501-505.
[5] Vieillard-Baron A，Caille V，Charron C，et al. Actual incidence of global left ventricular hypokinesia in
adult septic shock[J]. Crit Care Med，2008，36（6）: 1701-1706.
[6] Blanco J，Muriel-Bombín A，Sagredo V，et al. Incidence，organ dysfunction and mortality in severe sepsis: a Spanish multicentre study[J]. Crit Care，2008，12（6）: R158.
[7] Ilva T，Lassus J，Siirilä-Waris K，et al. Clinical significance of cardiac troponins I and T in acute
heart failure[J]. Eur J Heart Fail，2008，10（8）: 772-779.
[8] Liu M，Shehu M，Herrold E，et al. Prognostic value of initial elevation in cardiac troponin I level in
critically ill patients without acute coronary syndrome[J]. Crit Care Nurse，2015，35（2）: e1-e10.
[9] Arlati S，Brenna S，Prencipe L，et al. Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study[J]. Intens Care Med，2000，26（1）: 31-37.
[10] Favory R，Neviere R. Bench-to-bedside review: significance and interpretation of elevated troponin in
septic patients[J]. Crit Care，2006，10（4）: 224.
[11] Shapiro NI，Howell MD，Talmor D，et al. Serum lactate as a predictor of mortality in emergency department patients with infection[J]. Ann Emerg Med，2005，45（5）: 524-528.
[12] 徐小强，罗琼湘，胡春林，等. 早期动脉血乳酸清除率在评估严重脓毒症患者预后中的价值[J]. 中国急救医学，2015，35（7）:34-36.
[13] Cho SY，Choi JH. Biomarkers of sepsis[J]. Infection & Chemotherapy，2014，46（1）: 1-12.
[14] 谭兰婷，桂海波，杨桂香，等. 心肌损伤标志物联合 APACHEⅡ 评分在感染性休克患者预后判断中的价值[J]. 中国急救医学，2015，35（5）: 385-389.
[15] Lim W，Qushmaq I，Devereaux PJ，et al. Elevated cardiac troponin measurements in critically ill patients[J]. Arch Intern Med，2006，166（22）: 2446-2454.
[16] Mehta NJ，Khan IA，Gupta V，et al. Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock[J]. Intern J Cardiol，2004，95（1）: 13-17.
[17] John J，Woodward DB，Wang Y，et al. Troponin-I as a prognosticator of mortality in severe sepsis patients[J]. J Crit Care，2010，25（2）: 270-275.
[18] Cheng H，Fan WZ，Wang SC，et al. N-terminal pro-brain natriuretic peptide and cardiac troponin I for the
prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A
retrospective study[J]. J Crit Care，2015，30（3）: 654. e9-654. e14.
[19] Røsjø H，Varpula M，Hagve TA，et al. Circulating high sensitivity troponin T in severe sepsis and septic
shock: distribution，associated factors，and relation to outcome[J]. Intens Care Med，2011，37（1）: 77-85.
[20] Lim W，Cook DJ，Griffith LE，et al. Elevated cardiac troponin levels in critically ill
patients: prevalence，incidence，and outcomes[J].Am J Crit Care，2006，15（3）: 280-288.
[21] Yucel T，Memiş D，Karamanlioglu B，et al. The prognostic value of atrial and brain natriuretic peptides，
troponin I and C-reactive protein in patients with sepsis[J]. Exp Clin Cardiol，2008，13（4）:183.
[22] Tiruvoipati R，Sultana N，Lewis D. Cardiac troponin I does not independently predict mortality in
critically ill patients with severe sepsis[J]. Emerg Med Australasia，2012，24（2）: 151-158. |
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